Provider Demographics
NPI:1558397331
Name:MIKHAEL, MEDHAT FOUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEDHAT
Middle Name:FOUAD
Last Name:MIKHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16787 BEACH BLVD # 276
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4848
Mailing Address - Country:US
Mailing Address - Phone:714-340-7240
Mailing Address - Fax:562-595-0027
Practice Address - Street 1:3620 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3418
Practice Address - Country:US
Practice Address - Phone:562-595-0060
Practice Address - Fax:562-595-0027
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55997208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA005599700OtherMEDICAL
CA00A559970Medicaid
CA00A559970Medicaid
CAWA55997FMedicare PIN
CAG80926Medicare UPIN
CAWA55997EMedicare PIN